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NPI Code Detail

MEDICARE: BERKLEY PHYSICAL MEDICINE, PC

MEDICARE: BERKLEY PHYSICAL MEDICINE, PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208100000XPhysical Medicine & Rehabilitation Physician

General Provider Information

NPI Number : 1699007302
Entity Type Code : Organization
Provider Name (Legal Business Name) : BERKLEY PHYSICAL MEDICINE, PC
Provider Business Mailing Address
First Line : 26394 HUMBER ST
Second Line :
City : HUNTINGTON WOODS
State : MI
Zip : 48070-1222
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6700 W OUTER DR
Second Line :
City : DETROIT
State : MI
Zip : 48235-2724
Country : US
Telephone Number : 248-797-0860
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : HADASSAH R KREIMAN
Credential : M.D.
Telephone Number : 248-797-0860
Provider Enumeration Date : 02/04/2010
Last Update Date : 02/04/2010

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